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Inspection carried out on 20 May 2019

During a routine inspection

Letter from the Chief Inspector of General Practice

We rated this service as Good overall. (Previous inspection 9 October 2019 was not rated).

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at HR Healthcare on 20 May 2019 as part of our inspection programme. At our previous inspection on 9 October 2018 we found the service breached Regulation 12: Safe Care and Treatment because routine monitoring was not happening for patients with long term conditions, and Regulation 17: Good Governance because the service did not have a system to identify when patients changed their answers on a medical questionnaire. We issued a requirement notice in relation to the breaches.

HR Healthcare employs GPs on the GMC register, to work remotely in undertaking patient consultations when they apply for medicines online. Patients are able to complete a medical questionnaire which is then reviewed by a GP and the medicine is posted directly to the patient.

At this inspection we found:

  • The service had systems to manage risk so that safety incidents were less likely to happen. When they did happen, the service learned from them and improved their processes.
  • The service now had a system in place to ensure GPs were aware of any answers that had been changed when a patient was completing the online medical questionnaire.
  • Arrangements were in place to safeguard people, including arrangements to check patient identity.
  • The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
  • Staff involved and treated people with compassion, kindness, dignity and respect.
  • Patients could access care and treatment from the service within an appropriate timescale for their needs.
  • Patients were told about the risks associated with any medicines used outside of their licence.
  • Suitable numbers of staff were employed and appropriately recruited.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

  • Review assessment forms for each medicine and compare this against the company’s recommendations in the summary care characteristics.

  • The service should contact the patient if a letter is returned from a GP practice because the patient is not registered at that GP practice.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 9 October 2018

During a routine inspection

Letter from the Chief Inspector of General Practice

HR Healthcare was previously inspected at a different location on 22 November 2016 and we took urgent action to suspend the service for three months as the provider was not meeting the legal requirements for providing safe service. We then undertook a focussed inspection on 17 Jul 2017 to check what improvements had been made and we found that improvements had been made and the service was meeting the requirements of the regulations.

We carried out an announced comprehensive inspection at HR Healthcare on 9 October 2018 as part of our inspection programme.

HR Healthcare employs GPs on the GMC register, to work remotely in undertaking patient consultations when they apply for medicines online. Patients are able to complete a medical questionnaire which is then reviewed by a GP and the medicine is posted directly to the patient.

Our findings in relation to the key questions were as follows:

Are services safe? – We found some areas where the service was not providing a safe service in accordance with the relevant regulations.

Specifically:

  • Arrangements were in place to safeguard people, including arrangements to check patient identity.
  • We reviewed patient records and found that routine monitoring was not always happening for treatment of long term conditions.
  • The provider now ensured that patients were told about the risks associated with any medicines used outside of their licence.
  • Suitable numbers of staff were employed and appropriately recruited.

Are services effective? - We found the service was providing an effective service in accordance with the relevant regulations

Specifically:

  • Following patient consultations information was appropriately shared with a patient’s own GP in line with GMC guidance, with the exception of 17 consultations relating to asthma treatment that we identified as not being shared.
  • Quality improvement activity, including clinical audit, took place.
  • Staff received the appropriate training to carry out their role.

Are services caring? – We found the service was providing a caring service in accordance with the relevant regulations.

Specifically:

  • The provider carried out checks to ensure consultations by GPs met the expected service standards.
  • Patient feedback reflected they found the service treated them with dignity and respect.
  • Patients had access to information about GPs working at the service.

Are services responsive? - We found the service was providing a responsive service in accordance with the relevant regulations.

Specifically:

  • Information about how to access the service was clear and the service was available seven days a week.
  • The provider did not discriminate against any client group.
  • Information about how to complain was available and complaints were handled appropriately.

Are services well-led? - We found that in an area this service was not providing a well-led service in accordance with the relevant regulations.

Specifically:

  • We reviewed the medical questionnaire system and found that the answers given by patients could be changed before submitting for clinical review and no audit trail of this was kept by the service.

  • The service had clear leadership and governance structures.
  • There was a clear vision and set of values. The practice had a realistic strategy and supporting business plans to achieve priorities.
  • A range of information was used to monitor and improve the quality and performance of the service.
  • Patient information was held securely.

We identified regulations that were not being met and the provider must:

  • Ensure care and treatment is provided in a safe way to patients

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care

The areas where the provider should make improvements are:

  • The provider should improve information sharing with a patient’s GP before prescribing medicines which are liable to abuse or misuse.

You can see full details of the regulations not being met at the end of this report.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice